“One of the frustrations to researchers as well as health policy-makers is that because of the way the restructuring has been done in the past, there’s no evaluation with consistent measures to show the impact of the restructuring, whether it’s consolidation or devolution, on important outcomes like the health of the residents of the province,” said Camillo, an assistant professor with the Johnson Shoyama Graduate School of Public Policy at the University of Regina.

The Saskatchewan government has tasked a three-person advisory panel with finding how best to amalgamate health regions in a search for $7.5 million in annual administrative savings. The StarPhoenix researched what other provinces have done on that front and what lessons they’ve learned.

Nearly every province has enacted some form of consolidation since the turn of the century. The classic example is Alberta, which has gone from 17 health regions to a single Alberta Health Service, Camillo said.

However, she echoed former health minister Dustin Duncan’s remark that amalgamation is a small step to making health care sustainable.

“Most estimates are that most of the money spent on health care — which is a lot of money — is spent on hospital care, prescription drugs and physician care and very little is spent on administration. That doesn’t mean we shouldn’t look at the efficiencies but we have to remember that if we really want to, over time, get better value in health care, then we need to look beyond administrative efficiencies,” she said.

More is to be gained in renegotiating the province’s contract with the Saskatchewan Medical Association, which expires next March, she noted.

“If the government really wants to focus on value, I think that’s where it needs to invest and be very creative.”

University of Alberta professor John Church

John Church, an expert in health care reform at the University of Alberta, said amalgamation in and of itself doesn’t necessarily fix the major problems in the health care system.

“Despite the fact a lot of health regions have amalgamated their governance structures, primary care, for example, still remains largely unintegrated.”

Physicians are still independent contractors, so while they have a huge amount of control over how money is spent, they’re not accountable to health regions, Church said.

He and a colleague at Western University argue in a new article that health regions shouldn’t be blamed for things they can’t control. Politicians need the guts to think beyond governance, he said.

That could mean putting doctors on salary, or making more use of other health care providers such as registered nurses and nurse practitioners; research says they can do just about everything doctors can for a cheaper price, he added.

More supports, particularly for seniors, are also needed in the community to keep them out of hospital, Church said. That includes non-medical help with things like groceries, getting to appointments and taking their medications.

“Our numbers in terms of primary care access are terrible, our numbers in terms of wait times in general are terrible, so those are the big problems that never get fixed no matter how many times they rearrange the organizational deck chairs.”

A history of amalgamation

A 2013 report from the Institute of Public Administration of Canada, of which Camillo is a member, summarized the health governance reforms across Canada since the mid-2000s. Here’s what happened.

British Columbia: In 1993, B.C. had 20 regional boards and 82 Community Health Councils. In 1996 that dropped to 11 regional health boards, 34 community health councils and 7 community health services societies. In 2002 the government created a system of five regional health authorities and one provincial authority.

Alberta: Alberta Health Services was created in 2008 from the amalgamation of nine former regional health authorities, two provincial health boards and the Alberta Alcohol and Drug Abuse Commission.

Saskatchewan: In 2002, the province’s 32 health authorities merged into the current 12 regional health authorities.

Manitoba: In 2012, the government reorganized 11 RHAs into five bodies, eliminating 81 board positions. The amalgamation was meant to save $10 million over three years.

Ontario: The Local Health System Integration Act was passed in 2006, creating 14 local health integration networks (LHINs). Prior to this, health care was delivered on a provincewide basis by the Ministry of Health and Longterm Care, with District Health Councils advising on local needs.

Quebec: In 1992, regional councils were replaced with regional boards, which had greater responsibilities. The regional boards were transformed in 2003 into 18 health and social services agencies which have control over the local health and social services centres, community service centres, hospitals and long-term care facilities.

New Brunswick: In 2008 New Brunswick reduced its number of Regional Health Authorities to two from eight. According to the Provincial Health Plan 2008-2012, the former system “hindered the development of a truly integrated, uniform provincial health-care system.”

Nova Scotia: In 2001 the government expanded four regional health boards into nine district health authorities. In 2012 several administrative services were merged, including general administration, supply services, finance and payroll, and some laundry consolidation.

Newfoundland: The province in 2005 consolidated its many specialized health care boards into four health regions.

Prince Edward Island: In 1993, P.E.I. created the first comprehensive health boards in Canada. In 2005 they were dissolved, with responsibility transferred to the Department of Health. In 2010, the government transferred power to Health PEI, a Crown corporation operating at arm’s length from the Government.

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